53-year-old male. 71 inches tall. 200lbs. Admitted this a.m. with a diagnosis
of pneumonia. The patient is difficult to arouse and is a bit confused. He has an
IV running and is on the general floor. You are charged to see him
administer therapy.
Physical findings: Pulse 110bpm, BP 80/40, the temperature is 40°C, RR
32bpm and shallow, BS decreased in bases with crackles on inspiration,
cough is occasional, weak and nonproductive.
Labs: pH 7.56, CO2 23, PaO2 5, HCO3- 22, SaO2 79%-on 50% venti mask
Hgb 12.4, WBC 17.400, CXR on admission: bilateral patchy infiltrates
bases
Considerations: Pt is receiving oxygen via 50% venti mask. Other RT
orders: nebs q3hr with 0.5ml/3mlNS albuterol
1. Would you recommend placing this patient on mechanical
ventilation?
2. Does the patient have an oxygenation issue or ventilation issue? Is the
Is pH acidotic or alkalotic? Is the PaCO2 acidotic or alkalotic?
3. If you recommend mechanical ventilation, what would your initial
settings be?
4. What other recommendations do you suggest?
5. Would this patient have increased or decreased lung compliance?
What would you expect his peak pressures to be, increased or
decreased?
1. Yes, the patient should be placed on ventilator support because his saturation is very low (50% with venti mask) and he is hyperventilating.
By keeping the patient on mechanical ventilation we can improve the saturation as well as we can correct the acid-base imbalance.
2. In this case, the patient has oxygenation issues, its because the patient is hyperventilating but still his oxygen saturation is in the very low range(50% with venti mask).
The patient is alkalotic(pH is >7.45), due to PCO2 is alkalotic(< 35). So, its Respiratory alkalosis.
3. The patient should be placed on Volume control mode with low tidal volume(to avoid injury, because of lung air space is decrease due to fluid fill air sac) and high peep(To increase oxygenation).
The RR of the ventilator should be decreased to prevent CO2 washout and to correct the acid-base imbalance.
4.
- The patient should be treated with antibiotics to control infection and to resolve pneumonia.
- Diuretics can help to remove extra fluid from the lungs which can also improve oxygenation.
- The patient going towards septic shock, evidence by high WBC count and hypotension so keep the patient on vasopressors to maintain blood pressure and to maintain organ perfusion.
5.
In this case, there should be increased lung compliance due to fluid-filled air space.
Peak pressure is increased in this case because due to increased lung compliance, there is greater pressure required to deliver a normal amount of air into the lungs.
53-year-old male. 71 inches tall. 200lbs. Admitted this a.m. with a diagnosis of pneumonia. The patient...
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